Medico-legal aspects, standards and good clinical practices for the airway management in Europe

Anaesthesiology is safer now than ever before and, compared to other, is still among the leading disciplines with regard to patient safety. However some may consider “anaesthesiology” a risky endeavor. It has been proved that most causes of accidents in anaesthesiology are due to human factors and systems problems. The World introduction of the World Health Organization Surgical Safety Checklist has focused on fundamental aspect for clinical safety, including airway management, considered a cornerstone for perioperative patient safety, and moreover in critical care and emergency medicine. Even if the vast majority of airway and respiratory complications are considered predictable and could be avoidable, deficiencies in airway management have immediate catastrophic results for the patient and stress from medico-legal actions for the physician. To improve clinical outcomes and reduce medico-legal risk, anesthesiologists should improve the standards and adopt recognized good clinical practice. Every national Scientific Society should encourage the adoption of a minimum standard of care for airway management, defining algorithm, protocols, staffing and education/training needs, but airway equipment and patient monitoring must be standardized too. Within Europe, the importance to adopt a proactive strategy to improve the clinical safety have been underlined by the European Society of Anaesthesiology (ESA), by the European Board and Section of Anaesthesiology (EBA) of the Union Européenne des Médecins Spécialistes (UEMS) and specifically by the European Airway Management Society (EAMS): the training for a specialist in airway management must include the theoretical and practical aspects of airway techniques and a time-based environment that mimics clinical situations, but should also include risk management and medico-legal aspects.